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Question about rib fracture repair

  1. #1
    Pittsburgh Central
    Default Question about rib fracture repair
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    Good morning!

    One of my trauma surgeons is performing an open rib fracture repair on three ribs (4th, 5th, 6th) using an internal plating system.

    CPT 21805 is for rib fracture treatment without fixation & 21810 is for external fixation.

    What do you use for internal fixation only???

    Thank you for your help!

  2. Default
    Might want to ask your doc if he did indeed use a internal fixation and not a external fixator?

  3. #3
    Pittsburgh Central
    Yes, it was definitely internal only.

    He titles the OP note "Rib fracture repair - open with internal fixation using rib plating system by Acute Innovations."

    OP note reads:

    An incision was made from the tip of the scapula anteriorly
    for approximately 15 cm. This was carried down through the subcutaneous
    tissues and the muscle was divided using electrocautery. The portion of the
    latissimus and a small portion of his pectoralis were divided to access his rib
    fracture fragments. His ribs were cleaned off at the site of the fracture at
    the 5th rib and then again at the 6th rib. There was some fibrous nonunion at
    both rib sites and this was cleaned out and the edges of the fracture sites
    were reduced and placed in line. The 1st rib to be plated was the 6th rib and
    a 12 mm U-shaped plate was used after measurement. The plate was placed over
    the superior portion of the rib after it was cleaned off of all its muscular
    attachments and using the guide, holes were drilled into the bone and the
    appropriate color-coordinated screws were placed to affix the plate in place.

    Attention was then turned to the 5th rib where a similar procedure was
    undertaken to clean out the fibrous nonunion, reduce the ribs, align the ends
    and fit a U-shaped plate. Again, a 12 mm plate was used and secured in place
    using the guide.

    Attention was then turned to the 4th rib which was cleaned off in a similar
    manner and using the scapula retractor to gain optimal exposure, this rib was
    also reduced at the anterior fracture site, the fibrous malunion was excised
    and the rib ends reduced. A 3rd plate was placed over this rib and secured in
    place using the guide without any difficulties. At no point was the pleural
    space violated during application of the rib fracture plates and the entire
    procedure was performed through a single incision. The muscle was
    reapproximated using 2-0 Vicryl running suture. The fascia and subcutaneous
    tissues were reapproximated using 2-0 Vicryl sutures and the skin was stapled

  4. #4
    Pittsburgh Central
    dr wants to use CPT 32820 AND 21805-22

  5. Default
    I ccame up with 21899 unlisted code unfortunately

  6. #6
    Pittsburgh Central
    I was afraid of that!!!

    Thanks so much!

  7. #7
    Morgantown, WV
    Default Category iii codes
    I also had a hard time trying to figure out what code to use for rib loc plating (internal fixation). I do see in CPT 2011 that there is a Category III code (0245T). Has anyone every used a Cat III code before? I have not. Do you list it just like the other CPT's? thanks

  8. Default rcerro
    I use them with the orif of the ribs. They are payable for MCR with review as a status "C" catagory III code. I am having success in getting these paid with medical necessity. I starte with the catagory III code on them all, but some insurance comp (work comp, auto, smaller companies, and Medicaids) some times can't process it. In that event I switch it to an unlisted code. Good luck

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